Clinical Psych Midterm (1/25/25) Flashcards
1
Q
what is clinical psych
A
- integration
- application
- reducing maladaptation and distress
- increasing positive adaptation
2
Q
types of assessments
A
- intellectual batteries = IQ testing
- eduction focus = achievement, behavior
- neuropsychology = memory, language, functioning, behavior/emotional etc
- personality = formal inventories, projectivies
- interviewing
- observation
- forensic = testify
3
Q
formal diagnosis
A
- DSM-5/ ICD
- assessment usually results in diagnosis
- formal = number/title for billing purposes
4
Q
eclectic
A
- using more than one theory as a psychotherapist
- different theories for different clients: biology, development, contextual factors
- benefits: individualized therapy
- concerns: jack of all trades, master of none
5
Q
boating accident example
A
good qualities:
- calm and present
- asking questions
- validated the client’s feelings
- self-corrected based on what the client wants/needs
bad qualities:
- yelling/harsh
- not the right fit/vibe
6
Q
anorexia video example
A
bad qualities:
- calling everything stupid
- harsh
- not adapting/self-correcting when she was talking about how serious her disorder is
7
Q
19th century origins: empirical research
A
- Wundt in Germany
- Witmer in US: first applications to assessing and treating children for learning
8
Q
19th century origins: psychometric testing
A
- Cattell/Galton and Binet
- goal of testing: sorting people into categories
- originally meant to keep those at the top at the top (white supremacy)
9
Q
19th century origins: psychotherapy
A
- religious/supernatural explanations for psychosis
- medical models (4 humors, head shape)
- Charcot, Janet, Freud
10
Q
early 20th century: assessment and war
A
- assessing soldiers’ mental capacity during WWII - intellectual tests
- development of personality assessments
- broad expansion of measures
11
Q
early 20th century: advancements in psychotherapy
A
- psychoanalysis was dominated by psychiatry and med schools
- psychologists were brought in to help with treatment post-war
- development of work sites for psychologists: VA, community health clinics
12
Q
history of the APA
A
- originally for research psychologists
- some advocated for applying psych to help people
- others thought it would reduce scientific credibility
- was formally recognized post-WWII but no formal training for licensure for clinical psychologists yet
- 1940s: established procedures for training and certification
- 1949: Boulder meeting for training model
- 1953: first ethical guidelines
13
Q
theories of intervention: how do they differ
A
- assumptions about human nature
- origins of mental health issues: family dynamics, environment, genetics
- nature of the problem
- role of insight: how much it matters if the client knows/understands where form or why they have issues
- nature of therapeutic relationship: therapists as a real person, expert or guide/partner
14
Q
theories of intervention: psychodynamic approach
A
- negative view on human nature
- negotiate conflicts between id (devil) and superego (angel)
- ego is the mediator (self)
- people are not fully aware of themselves
- symptoms arise when unconscious conflicts are repressed (avoided): trauma/childhood events or relationship sequences
- insight is key to treatment: become aware of conflicts so ego can be freed from the past
15
Q
theories of intervention: humanistic approach
A
- people are inherently creative, good and inclined toward competence
- problems with self-awareness or externally imposed restrictions that can lead to mental health problems
- Phenomenology: perception is the reality and objective truth is irrelevant
16
Q
theories of intervention: Carl Rogers - conditions of worth
A
- other people give conditional love
- the conflict between sense of self and others’ judgements
- little emphasis on diagnosis
- therapist offers unconditional positive regard: empathy and congruence (genuine relationship)
- clients will figure things out for themselves if they are supported properly
- focus on present
- goal: full self-acceptance
17
Q
theories of intervention: behaviorism
A
- consistent with empirical/experimental psych roots
- problems develop through learned associations
- little albert
- key is to condition new responses
- little emphasis on how problems developed
- formal diagnosis not as important as behavior analysis - commonly used for anxiety/behavior problems
- school interventions
- goal setting and data collection
18
Q
theories of intervention: cognitive approaches
A
- problems develop when thoughts and expectations drive emotions and behavior
- personal constructs: expectations about the way things will go: social exchanges
- problems are due to inaccurate or oversimplified personal constructs
- perception = reality
- goal: make expectations more rational, logical and flexible
19
Q
theories of intervention: CBT
A
- cognitive and behavioral therapies merged in 1960s-70s
- Ellis: Rational-Emotive Behavior therapy
- more modern approaches focus on acceptance (ACT)
20
Q
behavior genetics and neuroscience
A
- role of medications
- both therapy and meds change the brain
21
Q
theories of intervention: systems approaches
A
- individual behavior is shaped and maintained by larger systems in social context
- family system
- tries to maintain homeostasis
- will push back against change
- people have prescribed roles
- boundaries and marital relationships - use larger family or group sessions
22
Q
diathesis-stressor model
A
- no mental health disorders are 100% heritable
- stressors may be life experiences but also from broader environment
23
Q
differential susceptibility model
A
- gene may seem bad in this environment but if they are placed in a different one they may flourish and do better than without said gene
24
Q
assessment basic questions
A
- what is the referral question
- what does the person want to know
- Who is the referral source: self, a teacher, parent, court, etc
- what information do you need to gather
- what sources of information would you pursue: teachers, parents, bosses
- how would you arrive at a diagnosis: testing, interview
- what are your major concerns or risks
- risks: harm to self or others
- concerns: dropping out, quitting job - what are the person’s strengths
- do you think the person is a good candidate for treatment
- What kind of treatment
25
standardized tests
- how the test is given: specific directions that must be followed
- how test is scored and interpreted
- depends on the standardization sample: bell curve, mean and SD
- if the standard deviation is not representative of the population than it is not reliable
26
standardized tests: benefits
- reduced interpreter bias
- helps level the playing field for things like admissions
27
standardized tests: disadvantages
- even though instructions are the same, sometimes people aren't able to understand the directions
28
intelligence testing - types
- Standford-Binet
- Weschler
- Nonverbal tests
29
intelligence tests - verbal/nonverbal
what do they measure:
- verbal/nonverbal: intelligence is associated with vocab and verbal ability
30
intelligence tests - fluid reasoning and crystallized knowledge
- fluid reasoning: ability to solve problems in front of you despite not having outside knowledge
- crystallized knowledge: stuff you already know, need to have access to education in some form
31
intelligence testing - working memory and processing speed
- working memory: ability to hold info for short period of time
- processing speed: how quickly can you take info in and spit it back out
32
intelligence tests: advantages
helpful for placing people in academic/gifted programs
33
intelligence tests: limitations
not a perfect solution for assessing intelligence
34
neuropsychology assessments: who needs them
- geriatric specialization: functioning of elderly people to find signs of cognitive decline
- traumatic brain injuries
- neurological conditions
- children/adolescents
35
neuropsychology assessments: basics of the brain
- development and pruning
- localization of function
- lateralization
- systems and integration
36
neuropsychology assessments: brain damage - occipital lobe
visual impairments
37
neuropsychology assessments: brain damage - parietal lobe: hemineglect and simultanagnosia
perceptual impairments
- hemineglect = don't perceive half of what is in front of you
- simultanagnosia = see things but not the full picture
38
neuropsychology assessments: brain damage - temporal lobe: visual agnosia, memory, temporal lobe epilepsy
- visual agnosia: see things but can't recognize it
- memory: cannot form new explicit memories
- temporal lobe epilepsy: see daily events as personally relevant/emotional (paranoia)
39
neuropsychology assessments: brain damage - frontal lobe
- executive functioning: planning, organization
- personality: no filter
- impulsivity, perseveration
40
neuropsychology assessments: types of tests
Intelligence/cognitive - what you are able to know/learn
Achievement: reading, writing, math - what do you already know
Language - receptive, expressive, pragmatic
Memory - visual, verbal, delayed, immediate, recognition, recall
Attention - impulsivity, distractibility, consistency
Executive functioning - panning, inference, perseveration
Visual-motor
Fine motor
Personality
Emotional/behavioral
41
personality testing: MMPI
- personality and psychopathology
- empirically derived
- gave questions to people who were already diagnosed with disorders and analyzed how they answered differently from "normal" people
42
personality testing: NEO-PI3 or MPQ normative personality
Big 5, mostly for research
43
personality testing: projectives
- inferences on personality
- Rorschach: ink blot
- TAT: storytelling based on a photo
- sentence completion
- drawings: useful for kids
- usually not very reliable or valid
44
psychopathology testing
- depression and anxiety inventories
- Child Behavior Checklist
- BASC: assesses positive adaptive skills and disorders, often for parents
- structured interviews
45
limitations of testing: effort
difficulty with children
long and time-consuming
46
limitations of testing: standardization
- sample may not be representative of person
- if directions are not understood
47
limitations of testing: cultural factors
- bias: access, previous knowledge (school)
- language
- communication
- stereotype threat: if you know there is a stereotype about your identity not doing well on this test, you will score worse
48
clinical interviewing: structured
- usually standardized: same questions, prompts and follow ups
- may have a decision tree
- higher reliability
- ex. SCID
49
clinical interviewing: semi-structured
- set of questions with flexibility for wording or follow-up
- requires good training because there isn't very much reliability
50
clinical interviewing: nondrirective/unstructured
- client-led with clinician interjection to gather necessary knowledge
51
clinical judgment vs clinical skill
there's no secret power to know what people have
but clinical skill could be knowing all the diagnose or having the right follow-up questions
52
purpose of interviews: research
quantitative: structured to see if people meet the criteria for your study
qualitative: semi-structured
53
purpose of interviews: diagnosis
- structured to make sure important info isn't missed
- can be a little semi-structured but not often unstructured
54
purpose of interviews: forensic
- structured to know what you are doing is reliable and valid
55
purpose of interviews: risk determination
- unstructured with interjecting questions can be good depending on the patient
- but structured can help because it could make the questions seem less important
56
purpose of interviews: part of a larger assessment
- structured battery because it is official for max validity and reliability
- unstructured can be good for having a convo after a series of other tests
57
purpose of interviews: beginning of therapy process
unstructured to build rapport with new patient
58
flow of the interview
set up
- what type of contact have you already had
- who made the appointment
opening
- greeting, introduction, rapport
middle
- substance of interview
closing
- keep an eye on the time so you don’t rush the end
- discuss the next steps
- See if they have any questions
59
what must be included in an interview
- introduction
- confidentiality and limits to confidentiality
- harm to others or self, children
- risk assessment
- how good are clinicians at predicting high-risk events - not very good
- low base rates
- Where do you draw the line: over-predictive suicidality or under-predictive
- Plan for follow-up
60
who will be interviewed
- individual, couple, family, court
- if a child: who do you see first, parent or child or together
- adolescent
- do you choose or should they choose
- relationship: together, separately
61
what factors influence the interview
- what do you know ahead of time
- what doesn't the client know what you know
- client willingness to participate
- your goal
- client’s goal
- culture
- client history
62
normal personality differences vs personality disorder
impairment = negatively affecting parts of their/ or other people’s lives
63
diagnostic paradox
- both hate diagnoses but want mental health to be taken seriously as a genuine issue
- don’t like labels and stigma, but want mental health parity laws
- criticize psychiatric disorders for being too general or changing science but fail to recognize that medical disorders often have the same issues
64
medical model: does the disorder have to reside within the individual
- doesn’t work for PTSD - the person didn’t have it at first and then they experience trauma
- do mental disorders get cured/go away
65
medical model: impairment criterion
- causes people to wait to get help until they hit rock bottom
- who decides the impairment
- wow do you assess impairment
- some people are high-functioning but that doesn’t mean they are fine
66
if a person had a diagnosis at one time and no diagnosis later does this mean:
- the person never really had the disorder?
- the person was cured/treated?
- the person grew out of the disorder?
67
if a diagnosis changes over time:
- is it the same problem, with heterotypic continuity?
- is it two different points along a pathway?
- was the first diagnosis wrong?
68
why is comorbidity so common
- chance
- methodology = how flexible are the diagnoses
- population under study - children who have been maltreated
- symptom overlap - depression + anxiety
- one disorder is an atypical form of another - theory that when boys were depressed they would act out (not a lot of evidence)
- one disorder causes or leads to another
- pathways with shared risks/trajectories
69
DSM I/II
psychoanalytic orientation
descriptions about how people got disorders
70
changes in the 1970s
- involvement of third-party payers - insurance
- people would go to therapy 5x a week
- changes in inpatient programs
- used to be that people stayed inpatient for months and years and insurance would pay
- professional competition
- Clinical practice
- medications - better meds
- new treatment models - CBT
- treating diseases vs life adjustment problems
- Psychiatry would treat diseases using a clearer DSM
71
DSM III
- developed by a small group of research-focused psychiatrists
- creation of a categorical diagnostic system following the medical model
- made causes/pathways irrelevant
- standardized for research and government programs
- encouraged the development of medications
- made diagnosis specialty of psychiatry
72
DSM-5
- removed the multiaxial system from DSM IV
- Group disorders that have common features
- Goes in developmental order = neurodevelopmental disorders first
- Revised some disorders
- moved things around based on research
- not longer than DSM-IV
73
categorical system pros
- encourages mental health treatment parity (legitimacy)
- helps differentiate distinct diagnoses (mood disorder vs thought disorder)
- improves reliability for research
- gives common language
74
categorical system cons
- fails to differentiate degree of disorder
- Fails to consider age, gender, or culture
- no consideration of pathways, etiology - how people get disorders, at-risk
- creates confining boxes that fail to capture the diversity of disorder
- may put disorders in separate categories that belong together
- no prevention
